An Economic Evaluation of the All New Zealand Acute Coronary Syndrome Quality Improvement Registry Program (ANZACS-QI 28)

Lee, Peter; Zomer, Ella; Liew, Danny

doi:10.1016/j.hlc.2019.08.012

Cited by 6 publications

(18 citation statements)

References 18 publications

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“…In 8 (24%) economic evaluations, the authors considered only the cost of the intervention, in 22 (61%) the intervention and direct medical costs were considered and 5 evaluations (15%) also included other indirect costs, such as the value of a statistical life year30 (table 2). In the 10 studies reporting costs per patient (all considered intervention +medical costs), the incremental costs of A&F compared with control were negative in one study (−194 Int.$2019) and varied between $4031 and $15 06432 Int.$2019 in others.…”

Section: Resultsmentioning

confidence: 99%

“…These limits were not addressed in the discussion for more than one-third of studies. Third, we observed significant heterogeneity in included costs; many evaluations only considered the direct costs of A&F and only one was conducted from a societal perspective 30. This lack of consideration of opportunity costs (eg, healthcare savings due to better patient outcomes, societal costs due to gains in productive life years), likely led to an underestimation of the economic value of A&F 40.…”

Section: Discussionmentioning

confidence: 99%

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Economic evaluations of audit and feedback interventions: a systematic review

et al. 2022

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BackgroundThe effectiveness of audit and feedback (A&F) interventions to improve compliance to healthcare guidelines is supported by randomised controlled trials (RCTs) and meta-analyses of RCTs. However, there is currently a knowledge gap on their cost-effectiveness.ObjectiveWe aimed to assess whether A&F interventions targeting improvements in compliance to recommended care are economically favourable.MethodsWe conducted a systematic review including experimental, observational and simulation-based economic evaluation studies of A&F interventions targeting healthcare providers. Comparators were a ‘do nothing’ strategy, or any other intervention not involving A&F or involving a subset of A&F intervention components. We searched MEDLINE, CINAHL, CENTRAL, Econlit, EMBASE, Health Technology Assessment Database, MEDLINE, NHS Economic Evaluation Database, ABI/INFORM, Web of Science, ProQuest and websites of healthcare quality associations to December 2021. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios, incremental net benefit and incremental cost-benefit ratios. Pairs of reviewers independently selected eligible studies and extracted relevant data. Reporting quality was evaluated using CHEERS (Consolidated Health Economic Evaluation Reporting Standards). Results were synthesised using permutation matrices for all studies and predefined subgroups.ResultsOf 13 221 unique citations, 35 studies met our inclusion criteria. The A&F intervention was dominant (ie, at least as effective with lower cost) in 7 studies, potentially cost-effective in 26 and was dominated (ie, the same or less effectiveness and higher costs) in 2 studies. A&F interventions were more likely to be economically favourable in studies based on health outcomes rather than compliance to recommended practice, considering medical costs in addition to intervention costs, published since 2010, and with high reporting quality.DiscussionResults suggest that A&F interventions may have a high potential to be cost-effective. However, as is common in systematic reviews of economic evaluations, publication bias could have led to an overestimation of their economic value.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Economic evaluations of audit and feedback interventions: a systematic review

et al. 2022

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“…The cost of providing RUFIT-NZ across the three rugby clubs was estimated through micro costing (see Appendices ). Although no official willingness-to-pay threshold has been established for NZ, contemporary economic analyses have considered a gross domestic product per capita expenditure of $45,000 per QALY to be cost-effective [ 42 , 43 ]. All costs were expressed in $NZD in 2021 using the consumer price index (CPI) [ 44 ].…”

Section: Economic Analysismentioning

confidence: 99%

Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs

Maddison

Jiang

Calder

et al. 2023

Int J Behav Nutr Phys Act

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Background A healthy lifestyle program that appeals to, and supports, overweight and obese New Zealand (NZ) European, Māori (indigenous) and Pasifika men to achieve weight loss is urgently needed. A pilot program inspired by the successful Football Fans in Training program but delivered via professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, adherence to healthy lifestyle behaviors, and cardiorespiratory fitness in overweight and obese men. A full effectiveness trial is now needed. Aims To determine the effectiveness and cost effectiveness of Rugby Fans In Training-NZ (RUFIT-NZ) on weight loss, fitness, blood pressure, lifestyle change, and health related quality of life (HRQoL) at 12- and 52-weeks. Methods We conducted a pragmatic, two-arm, multi-center, randomized controlled trial in NZ with 378 (target 308) overweight and obese men aged 30–65 years, randomized to an intervention group or wait-list control group. The 12-week RUFIT-NZ program was a gender-sensitised, healthy lifestyle intervention delivered through professional rugby clubs. Each intervention session included: i) a 1-h workshop-based education component focused on nutrition, physical activity, sleep, sedentary behavior, and learning evidence-based behavior change strategies for sustaining a healthier lifestyle; and 2) a 1-h group-based, but individually tailored, exercise training session. The control group were offered RUFIT-NZ after 52-weeks. The primary outcome was change in body weight from baseline to 52-weeks. Secondary outcomes included change in body weight at 12-weeks, waist circumference, blood pressure, fitness (cardiorespiratory and musculoskeletal), lifestyle behaviors (leisure-time physical activity, sleep, smoking status, and alcohol and dietary quality), and health-related quality of life at 12- and 52-weeks. Results Our final analysis included 200 participants (intervention n = 103; control n = 97) who were able to complete the RUFIT-NZ intervention prior to COVID-19 restrictions. At 52-weeks, the adjusted mean group difference in weight change (primary outcome) was -2.77 kg (95% CI -4.92 to -0.61), which favored the intervention group. The intervention also resulted in favorable significant differences in weight change and fruit and vegetable consumption at 12-weeks; and waist circumference, fitness outcomes, physical activity levels, and health-related quality of life at both 12 and 52 weeks. No significant intervention effects were observed for blood pressure, or sleep. Incremental cost-effective ratios estimated were $259 per kg lost, or $40,269 per quality adjusted life year (QALY) gained. Conclusion RUFIT-NZ resulted in sustained positive changes in weight, waist circumference, physical fitness, self-reported physical activity, selected dietary outcomes, and health-related quality of life in overweight/obese men. As such, the program should be recommended for sustained delivery beyond this trial, involving other rugby clubs across NZ. Trial registration Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered 18 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376740 Universal Trial Number, U1111-1245–0645.

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“…International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10) codes were used to identify the following ACS subgroups: non-ST elevation MI (NSTEMI) (I21.4 and I22.2), ST-elevation MI (STEMI) (I21.0-I21.3, I22.0, I22.1, I22.8 and I22.9), unstable angina (UA) and 'MI unspecified' (I21.9). 4 Patients were excluded from the analysis if they were not residents in New Zealand, or if hospital length of stay (LOS) exceeded 8 weeks. 1 2 Hospital LOS greater than 8 weeks were likely attributed to non-ACS comorbidities, resulting in an overestimation of admissions costs through undue weight in statistical analyses.…”

Section: Datamentioning

confidence: 99%

“…3 4 We had recently published an economic evaluation of ANZACS-QI, and found that there were considerable costs attributed to MI readmissions and deaths over a 4-year period. 4 However, to date, no study has evaluated the cost of ACS in New Zealand, nor the decline in these with the decreasing burden of ACS over time. Therefore, in this study, we sought to estimate the costs of hospital admissions…”

Section: Introductionmentioning

confidence: 99%

Estimating the economic impact of acute coronary syndrome in New Zealand over time (ANZACS-QI 64): a national registry-based cost burden study

et al. 2022

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ObjectivesTo estimate the changes in costs associated with acute coronary syndrome (ACS) admissions in New Zealand (NZ) public hospitals over a 12-year period.DesignA cost-burden study of ACS in NZ was conducted from the NZ healthcare system perspective.SettingHospital admission costs were estimated using relevant diagnosis-related groups and their costs for publicly funded casemix hospitalisations, and applied to 190 364 patients with ACS admitted to NZ public hospitals between 2007 and 2018 identified from routine national hospital datasets. Trends in the costs of index ACS hospitalisation, hospital admissions costs, coronary revascularisation and all-cause mortality up to 1 year were evaluated. All costs were presented as 2019 NZ dollars.Primary outcome measuresHealthcare costs attributed to ACS admissions in NZ over time.ResultsBetween 2007 and 2018, there was a 42% decrease in costs attributed to ACS (NZ$7.7 million (M) to NZ$4.4 M per 100 000 per year), representing a decrease of NZ$298 827 per 100 000 population per year. Mean admission costs associated with each admission declined from NZ$18 411 in 2007 to NZ$16 898 over this period (p<0.001) after adjustment for key clinical and procedural characteristics. These reductions were against a background of increased use of coronary revascularisation (23.1% (2007) to 38.1% (2018)), declining ACS admissions (366–252 per 100 000 population) and an improvement in 1-year survival post-ACS. Nevertheless, the total ACS cost burden remained considerable at NZ$237 M in 2018.ConclusionsThe economic cost of hospitalisations for ACS in NZ decreased considerably over time. Further studies are warranted to explore the association between reductions in ACS cost burden and changes in the management of ACS.

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An Economic Evaluation of the All New Zealand Acute Coronary Syndrome Quality Improvement Registry Program (ANZACS-QI 28)

Cited by 6 publications

References 18 publications

Economic evaluations of audit and feedback interventions: a systematic review

Economic evaluations of audit and feedback interventions: a systematic review

Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs

Estimating the economic impact of acute coronary syndrome in New Zealand over time (ANZACS-QI 64): a national registry-based cost burden study

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